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Variable Name:Indicator 2.4: Flourishing for children and adolescents, age 6-17 years

Survey Items:Survey instrument item number for children 6-11 years: A3a-c; for children 12-17 years: A3a-c
Variable in public use data file: K6Q71_R; K7Q84_R; K7Q85_R

Denominator:Children age 6-17 years

Numerator:Children who met 0-1 flourishing items; Children who met 2 flourishing items; Children who met all 3 flourishing items

Revisions and Changes:Response options were changed from “Never, rarely, sometimes, usually, or always true" to "Definitely true, somewhat true, or not true." Reference to “the past month” was not included in the 2016 NSCH question. For more information about the changes, click here.
Due to changes in the survey’s mode of data collection and sampling frame, as well as adjustments to item wording where necessary, MCHB alerts data users that it is not be possible to compare estimates from the redesigned survey to those from previous iterations of the NSCH or NS-CSHCN or to conduct related trend analyses. The redesigned NSCH will support trend analyses beginning with data from 2016.

Additional Notes:Positive health items, or “flourishing items” (also known as thriving), were included first time in the 2011/12 NSCH to provide information on childhood well-being and resilience. Flourishing as a concept contains multiple dimensions of physical health, mental and emotional health, caring, empathy and resilience, therefore items are organized by domains within thriving. Questions were developed based on a review of positive health indicators by a Technical Expert Panel. This TEP includes a representative group of experts in the field of survey methodology, children's health, community organizations, and family leaders. Additionally, there was a public comment period which yielded more interesting in this concept. From the collection of input from the Technical Expert Panel and Public Comment, two sets of flourishing items were developed for children age 6 months-5 years and a separate set for children 6-17 years based on developmentally appropriate experiences for each age group. For children age 6-17 years, three questions were asked that aimed to capture curiosity and discovery about learning, resilience, and self-regulation. These were captured through: (1) child shows interest and curiosity in learning new things, (2) child works to finish tasks he or she starts, and (3) child stays calm and in control when faced with a challenge. The "Definitely true" response to the question indicates the child meets the flourishing item criteria.

Treatment of Unknown Values:Missing values due to non-response or a “don’t know” response are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the data query results table. In the majority of cases, the proportion of missing values is less than 2%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). If missing cases are handled in any other way, details can be found in the "Additional notes" section above.

History and Development:The Maternal and Child Health Bureau (MCHB) funds and directs the National Survey of Children’s Health (NSCH), and develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. The U.S. Census Bureau conducts the survey, oversees the sampling, and produces a final data set of survey results. Respondents’ cognitive understanding of the survey questions was assessed during the pretest phase and revisions were made. Previously validated questions and scales are used when available.
Prior to 2016, the NSCH and the National Survey of Children with Special Health Care Needs were each conducted three times as interviewer-assisted telephone surveys using random digit dial sampling. In 2016, the two surveys were combined into a single self-administered questionnaire. Due to decline in the number of households with landline telephones, the NSCH now utilizes an address-based sampling method to select participating households, thus all invitations are sent by mail. Participants may choose to complete the survey either online using a secure website or a mailed paper version of the survey.
All final data components are verified by the Census Bureau, MCHB and DRC/CAHMI staff prior to public release. More information can be found in the “Review the Surveys” section of this website.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U59MC27866,National Maternal and Child Health Data Resource Initiative, $4.5M. This information or content and conclusions are those of the author and should not be construed as the official position of or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.